Diving into Data and Documentation
At the beginning of June, I was given the opportunity to rotate into the Quality Assurance office at my agency. It is a six-month assignment that I will wrap up in the beginning of December, and I have enjoyed it immensely. It has given me flashbacks to my early days of using data to make choices in my old BLS service in the early 2000’s and reviewing charts at my first job. It has also been a huge learning experience and reignited my passion for improvement science and clinical education. I’ve enjoyed getting a behind the scenes look at how we can use data to drive system wide clinical improvement and evaluate system performance and use it to also improve individual performance. Here are a few of the things that I have learned, so far:
1) Document. Document. Document. I genuinely believe that 99.9999% of people in EMS want to do the right thing, want to do good work, and take care of people. As jaded as we may be, we wouldn’t be here otherwise. Whenever I come across an issue in a chart, or there is a question of a treatment choice or clinical decision, most of the time it is either unclear documentation, incomplete documentation, or conflicting documentation within a chart. While charting isn’t the fun part of the job, it is one of the most important parts. Whether we realize it or not, in a lot of places our documentation is used down the line to drive clinical decisions in the hospital, it is also used to evaluate system performance and can also obviously be used in civil and criminal lawsuits. Having consistent systemwide documentation standards can help, but taking individual pride in your charting is just as important as how neat your uniform is, how clearly you communicate with your patients, and how clinically competent you are.
2) One of the things I learned through the Institute for Healthcare Improvement is the model for improvement and the concept that while all changes do not lead to improvement, all improvement requires change. Having a clear aim statement and knowing exactly what you are trying to accomplish is important, as is being able to identify how we will know that a change is an improvement. Change for the sake of change is disruptive and rarely a long-term fix to a problem. PDSA cycles should be based on clear aim statements and goals. Change for the sake of change is chaos.
3) Data output is only as good as the data used to create it. I never knew I would dislike free-text fields in a patient care report as much as I do now, because trying to pull reports and clear data from them is way more difficult than other multiple-choice fields. Even then, not accounting for documentation errors or incomplete documentation can skew results. How have I learned to overcome this? I haven’t yet, other than being thorough, identifying outliers and accounting for them, and using feedback to hopefully improve documentation practices in the future. Using dirty data to drive decisions can be detrimental to performance.
4) Speaking of feedback, feedback is everything. One of my favorite parts of this job so far is reading a PCR from a crew that just nailed it and recognizing them for it. It doesn’t have to be much, but I think just a quick “good job” means a lot. It does to me when I get them when I’m out on the street. Getting consistent positive feedback makes getting occasional constructive feedback easier as well. We take care of a lot of sick people, and lots of not so sick people, but seeing at a system level how well we take care of our patients is awesome.
5) System level change is way more complicated than I am guilty of assuming it was. Providing equitable, consistent care across 450 providers and 850 square miles is complicated, and requires planning, oversight, feedback and leadership across multiple interagency disciplines including operations, training, logistics and medical affairs. We are a “quick fix” type of people. We want change now, to implement things yesterday, and always be on the cutting edge of everything, but I understand now more than ever, that it is not always that easy.
My time “in the office” is going to wrap up in the next couple of months, but I have appreciated the experience and the opportunity to look at things through a different lens. Remember: clear, concise and complete documentation drives care, and dirty data damages decisions. I cannot wait until EMS World in Indy in a few weeks, hope to see you there!
